Ask the CaRMS Selection Committee member

[samsara]

Hello,
To start off, thank you very much for doing this. It is invaluable.
A few questions:
1) Is a candidate with the lions share of electives in his/her home province at a disadvantage when it comes to being granted an interview at your institution?
2) Are letters from general internists preferred over letters from subspecialists?
I ask because at our institution, we have a "core internal" rotation for 6 weeks followed by an "internal selective" in a subspecialty for 4. I happened to have better rapport/spent more time with the subspecialist and my reference letter choice reflects this. Please comment.
3) How are international electives viewed by the selections committee?
Thank you again,
Season's greetings!

[Internist]

Originally Posted by samsara

1) Is a candidate with the lions share of electives in his/her home province at a disadvantage when it comes to being granted an interview at your institution?

No, at least not directly. However, by not having any electives with us specifically, there is no way, of course, that we can ever see first hand how excellent they are. So, even though they won't be penalized, they will, in fact, still tend to slip down the list a bit by virtue of the fact that others (who did do an elective with us, and did an outstanding job) will have been moved up.

2) Are letters from general internists preferred over letters from subspecialists?

Yes, if they are from a CTU rotation. Likewise, a specialist who knows the candidate by virtue of supervising him/her on a CTU (when they, the staff, were functioning as de facto general internists) makes an excellent choice for a reference

3) How are international electives viewed by the selections committee?

In my opinion, neither here nor there (pardon the pun). What counts is the reputation of the supervisor (or, what is much more often the case, our total lack of any knowledge about the elective supervisor/preceptor). So, for example, a reference arising from an elective taken in Asia or Africa with someone we've never heard of, and have no sense of, must be interpreted with great caution. By definition, such a reference won't be weighted heavily by us. Hence, it isn't usually a great choice. That being said, the very fact that a candidate wanted to go to, say, Africa, and put it together, speaks volume about his/her character and initiative and can be, therefore, a real plus. (How's that for equivocating?)

[lostintime]

Thanks again for taking the time to answer questions Internist! I was just wondering what's a good length of time for a CTU elective at Toronto and if there is enough time to get to know an attending to obtain a reference letter. For instance, how often do attendings change on CTU?

Also, are there any strategies in terms of scheduling electives? I heard many programs do not let you know until months after which means you could be left without any elective. If a CTU elective you pick fills up, will we be put into a subspecialty elective that is available or will we be left with no time to apply for anything else?

Happy holidays!

[Internist]

Originally Posted by lostintime

what's a good length of time for a CTU elective at Toronto and if there is enough time to get to know an attending to obtain a reference letter. For instance, how often do attendings change on CTU?

In my opinion (and I doubt there would be a general consensus by my colleagues on the Committee), at least two weeks are needed to show your skills and abilities to the point of providing a good basis for a reference letter. I, personally, don't give a lot of credence to letters written by someone who knows the student for just one week. The exception to this might be where the letter writer was one of several supervisors each in charge for, say, a week and where it's stated explicitly that the input of the other preceptors has been sought and incorporated into the letter.

Also, are there any strategies in terms of scheduling electives? I heard many programs do not let you know until months after which means you could be left without any elective. If a CTU elective you pick fills up, will we be put into a subspecialty elective that is available or will we be left with no time to apply for anything else?

I really don't know how this works. In fact, it's not even clear to me how this works in my own division, let alone elsewhere in the province (or country).

I agree, however, that it can be very difficult to get an elective arranged for a specific time and duration, and almost impossible to insure you get a specific preceptor. This is one reason why taking an elective with the "right" type of subspecialist may be preferable to the usual CTU elective, i.e. subspecialists can usually commit to specific dates and, critically, do not assign you to a colleague (or what's worse, a senior resident) if they can't do it themselves. If nothing else, it's far easier to get a straight answer from a subspecialist.

What is the "right" type of subspecialist for a reference letter? I'd say, and this is all just my opinion, that you're looking for as many as possible of the following:

1. he/she should be known and respected by the members of your centre's PGY1 selection committee (often this simply translates into it being someone senior and/or someone who was/is a Royal College examiner in Internal Medicine (not his/her subspeciality))

2. ideally he/she should attend on the CTUs (at least occasionally) and not just on his/her subspeciality

3. he/she should have some experience in writing these types of letters. Frankly, you don't want someone who's prone to understatement. Further, he/she should have some sense for what the Committee is looking for. Again, this may simply be another way of saying that you want someone senior, or more to the point, someone who's had LOTS of students over the years. By now, such a person will often seem to know intuitively the type of things to note in the letter (e.g. comparative assessments with other students he/she has had).

What is not emphasized enough in choosing references is (and as always this is just my opinion and experience) that many subspecialist letter writers feel compelled to address each and every point on the list of instructions provided by CaRMS. That almost always has the effect of diluting down the letter (since, for example, there are going to be some areas where the referee won't have much to say and then winds up sounding blase or unenthusiastic, at least with respect to those areas). The bottom line is that such letters will usually contain sections that sound very average. What you want is a letter that from beginning to end, and everywhere in between, is unequivocally positive, and in the strongest possible terms. The reader should have no doubt that you're excellent and it shouldn't matter where his/her eyes fall if they just skim the letter - they should "always" land on words of high praise (and not on, for example, some feeble attempt to describe your research abilities or ability to do procedures simply because the CaRMS instructions said that those areas should be addressed.) An experienced, and confident, referee, doesn't feel he/she must address every last area, eg. procedures. In fact, an experienced, confident letter writer often seems to pay no heed to the CaRMS instructions! But that can be a very good thing since it allows the writer to speak in free text about you, rather than in the stilted manner which usually results from addressing all the items in a list. It also allows much more readily for statements of praise to be included - again, it's not always easy to do so in a letter based on a formal list of areas to appraise and on which to report.

Don't quote me, but you may want to tell your referees that they can safely ignore the specifics of the CaRMS instructions. What matters is that they say who they are (rank, position, etc), how they know you and for how long (and, recall, only letters from people you've worked with clinically count for much), and speak to your knowledge and skills, intellectual ability, judgment, work ethic, reliability, enthusiasm, collegiality and team relationships, patient family interactions, and did I mention knowledge and work ethic? And how about knowledge and work ethic? And reliability? . . .

[ddocs]

Thanks for all the great insight Internist...very helpful indeed.

I was wondering whether you can shed some insight on IMG admissions to UofT's Internal Medicine??!! Cheers.

[hastin11]

Hey internist, thanks for all this!

How many total weeks of electives do you think should be done in the field you are applying to prior to the interview invites? For example, say you have 10 potential weeks of elective time before the interview invites, would 4 weeks of electives in the specialty be OK, if say 2 of the weeks are at the site you are applying to? What is your feel on this?

[AK81]

Hi, can you tell us how long the interview day will be for UofT and what type of questions they will ask?

[Averance]

Hi Internist,

First I'd like to thank you for taking your time answer all of these CaRMs questions that we constantly barrage you with. They are very insightful.

I'd like to as you a question regarding CaRMS interviews. After receiving word from all my interview programs, I was rejected from two interviews. One of the schools is one that I really want to attend (or at least have a shot) or attending.

I have heard hearsay about students previously contacting the program and appealing their case. What is your take on this?

Thanks.

[bigtymer]

Hey Internist,

I'm an IMG and I will be interviewing at Toronto for IM. I've read the forum and info you've put up regarding Canadian grads. Is the IMG selection process the same except for the fact that instead of a school academic record you use the Canadian board exams?

[Internist]

Originally Posted by ddocs

I was wondering whether you can shed some insight on IMG admissions to UofT's Internal Medicine??!! Cheers.

Sorry, that's not something I'm involved with. I'd just be guessing, and you don't want that.

Originally Posted by hastin11

How many total weeks of electives do you think should be done in the field you are applying to prior to the interview invites? For example, say you have 10 potential weeks of elective time before the interview invites, would 4 weeks of electives in the specialty be OK, if say 2 of the weeks are at the site you are applying to? What is your feel on this?

I'm not sure I understand. For Internal Medicine, everyone already will have exposure to the area through their own CTUs. If you are wondering whether it pays to demonstrate your interest in Internal by taking electives in it (or a specialty) in addition to your core rotation, yes, I think that helps. If nothing else it confirms you are committed. Further, as I think you are implying, it's a chance to get known by at a different university (or even by different people at the same one - this is important insofar as the more, and the more diverse, support you have at your own centre, the better off you'll be).

It's also good to take electives to simply improve. That can be a very wise thing if you can arrange the elective before your core CTU rotation. Doing so will cause you to arrive at the CTU with advanced skills and knowledge compared to your peers. Yes, I know that sounds a bit venal, but it IS after all your career on the line.

Electives in a medical subspecialty (e.g. rheum, cardio, or endo) are, of course, worthwhile in and of themselves. Still, from the CaRMS perspective, they're even better if you take such an elective with someone who is respected by the PGY1 selection committee(s) of where you want to go.